ESPN 53rd Annual Meeting

ESPN 2021


 
Diagnostic value of serum cardiovascular (CV) biomarkers to detect subclinical CV disease (CVD) in children with chronic kidney disease (CKD)
KAROLIS AZUKAITIS 1 JUSTINAS DARASKEVICIUS 2 MARIETTA KIRCHNER 3 FRANZ SCHAEFER 4 ON BEHALF OF 4C STUDY CONSORTIUM 5

1- CLINIC OF PEDIATRICS, INSTITUTE OF CLINICAL MEDICINE, FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
2- FACULTY OF MEDICINE, VILNIUS UNIVERSITY, VILNIUS, LITHUANIA
3- INSTITUTE OF MEDICAL BIOMETRY AND INFORMATICS, UNIVERSITY OF HEIDELBERG, HEIDELBERG, GERMANY
4- DIVISION OF PEDIATRIC NEPHROLOGY, CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG UNIVERSITY HOSPITAL, HEIDELBERG, GERMANY
5- 4C STUDY CONSORTIUM
 
Abstract:

Objectives: Serum levels of biomarkers associated with CV stress are increased in children with CKD and after kidney replacement therapy (KRT). We aimed to evaluate the diagnostic performance of traditional (TnT and BNP) and novel (GDF15 and ST2) CV biomarkers to detect subclinical CV disease (CVD) in children with CKD and under KRT.

Methods: Biomarker levels were measured in 120 children with CKD stage 3-5, 95 of whom started KRT (n=53 dialysis and n=42 kidney transplantation (KTx)). CV endpoints were defined as left ventricular hypertrophy (LVH, left ventricular mass index >45 g/m2.16), increased carotid intima-media thickness (cIMT; >95th percentile) and increased pulse wave velocity (PWV; >95th percentile). Logistic regression with ROC analysis using sum maximization was applied to assess diagnostic performance in each subgroup (non-KRT, dialysis and KTx) cross-sectionally.

Results: TnT and BNP in the non-KRT group was associated with higher odds of LVH, BNP in the dialysis group was associated with increased PWV, while GDF15 associated with LVH in the KTx group. The ability of the biomarkers to discriminate patients with the presence of subclinical CVD was poor-to-fair. (Table)

 

Biomarker (per doubling)

CV endpoint

OR

AUC

Cut-off value

Sensitivity

Specificity

CKD (n=120; 13.2 years, eGFR 14.3 ml/min/1.73 m2)

TnT

LVH

2.24

0.66

0.008 ng/mL

93%

35%

BNP

1.35

0.63

0.45 pg/mL

37%

79%

Dialysis (n=53; 15.0 years, eGFR 8.8 ml/min/1.73 m2)

BNP

PWV

1.44

0.73

1.26 pg/mL

77%

72%

KTx (n=42; 14.9 years, eGFR 57.8 ml/min/1.73 m2)

GDF15

LVH

3.26

0.72

1195 pg/mL

44%

92%

Conclusions: Serum biomarkers of CV stress (TnT, BNP and GDF15) are associated to a varying extent with higher odds of LVH or increased PWV in children with CKD and under KRT. Their sensitivity and specificity to detect subclinical CVD, however, is relatively poor.